Value of Cognitive Assessment and Brain Fitness
for Improving Memory and Preventing
Behavioral Disturbances
Presented by Susan Kraus, MSN, CRNP-PMH, CRNP-A
Faculty, The BCAT
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Neuro-Cognitive Domains
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The basics of primary neuro-cognitive domains in
everyday living
Structure-function
Neurons
Basic brain structures
NEURO-COGNITIVE DOMAINS
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Basic Brain Structures
Whole Brain
NEURO-COGNITIVE DOMAINS
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Basic Brain Structures
Frontal Lobes
Executive Processes
NEURO-COGNITIVE DOMAINS
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Basic Brain Structures
Temporal Lobes
Learning & Memory
NEURO-COGNITIVE DOMAINS
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Basic Brain Structures
Parietal Lobes
Attentional Awareness of the Environment
NEURO-COGNITIVE DOMAINS
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Basic Brain Structures
Hippocampus
Early Memory Stage
NEURO-COGNITIVE DOMAINS
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The Three Central Cognitive Domains
(The Cognitive Task Manager)
Contextual memory
The case of story recall
Executive functions
The case for executive controls
Attentional capacity
The case for attention as “the oil”
NEURO-COGNITIVE DOMAINS
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Utility of Cognitive Screening Tools
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The utility of cognitive screening tools
We have an aging society with associated problems.
As people live longer, the incidence/prevalence of
dementia rates increase.
Over 5 million people have Alzheimer’s disease (AD),
anticipated to be 13 million by 2050.
Numbers are vastly greater if you include other dementias
and people with Mild Cognitive Impairment (MCI).
UTILITY OF COGNITIVE SCREENING TOOLS
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When to use screening tools
U.S. Preventive Services Task Force Statement
Routine screening versus screening when there
is a subjective or objective memory complaint
Age as risk factor and screening for people over 80
The special case of MCI and dementia conversion (1015% annually)
UTILITY OF COGNITIVE SCREENING TOOLS
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Uses of screening tools
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Aide in diagnosis
Early recognition enhances efficacy of treatments
Improve disease management and planning
Identify functional issues
Manage expectations of patients, families, providers, staff
Time and cost effective
Lowers patient resistance and encourages compliance
UTILITY OF COGNITIVE SCREENING TOOLS
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What should a good cognitive screening tool be able
to do?
• Administered by professionals and techs
• Completed in less than 15 minutes
(sometimes five minutes)
• Able to differentiate between MCI and dementia
• Broadly assess memory skills
• Broadly assess executive skills
• Assess attentional skills
• Predict ADLs & IADLs
UTILITY OF COGNITIVE SCREENING TOOLS
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Commonly used cognitive screening tools
Mini-Mental State Examination (MMSE)
Short Test of Mental Status (STMS)
Montreal Cognitive Assessment (MoCA)
Saint Louis University Mental Status Examination (SLUMS)
Brief Cognitive Assessment Tool (BCAT) & BCAT-SF
COMMONLY USED SCREENING TOOLS
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MMSE (Folstein, Folstein, & McHugh, 1975)
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The first major screening instrument
Sensitive for moderate to severe dementia
Less sensitive for MCI and mild dementia
Education bias (overestimates for those with
little education)
• Weak on memory and executive functions
• Floor effect
COMMONLY USED SCREENING TOOLS
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STMS (Kokmen et al., 1987)
• Verbal features are more complex than MMSE
• Relatively poor sensitivity to MCI
COMMONLY USED SCREENING TOOLS
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MoCA (Nasreddine et al., 2005)
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Sensitive to cognitive spectrum
Designed primarily for frontline providers
Relatively weak on memory
No story recall component
Stronger on executive functions, but no complex
reasoning item
COMMONLY USED SCREENING TOOLS
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SLUMS (Tariq et al., 2006)
• Sensitive to cognitive spectrum
• Designed primarily for frontline providers
• Has a story recall, but no free recall or delayed
recall
• Has complex reasoning, but no cognitive
set-shifting
COMMONLY USED SCREENING TOOLS
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BCAT (Mansbach, MacDougall, & Rosenzweig 2012)
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Four studies, starting in 2005
21 items, 50 maximum points
10-15 minutes in administration
Has a MCI versus dementia “cut” score (37/38)
Has score ranges for cognitive categories
Has three cognitive “clusters”
Predicts ADL & IADL
Website-based scoring program
COMMONLY USED SCREENING TOOLS
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BCAT Test
THE BCAT
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT Item Detail
BCAT ITEM DETAIL
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BCAT: The 3 Clusters
1. Contextual Memory
Immediate Story Recall
Delayed Story Recall
Story Recognition
Orientation
example
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THE THREE CLUSTERS
“Carol borrowed $10 from her brother Jack last week. She couldn’t
pay him back because she bought a delicious ice cream cone at
the circus.”
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BCAT: The 3 Clusters
2. Executive Functions
Verbal Trails (OTMT)
Mental Control (days of the week, backward)
Judgment
Arithmetic Reasoning
Digits Backward
example
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THE THREE CLUSTERS
“Suppose you have a 1 PM appointment with your doctor. It takes
45 minutes to get there. What time is the latest you can leave to
get there at 1 PM?”
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BCAT: The 3 Clusters
3. Attentional Capacity
Immediate Word List
Naming
Letter List
example
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Banana…
THE THREE CLUSTERS
Justice…
Sara…
Bridge…
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BCAT Scoring Program
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BCAT Scoring & Interpreting
Computer-assisted scoring
Total score & Factor scores
Clinical considerations
Report that can be printed and/or emailed
BCAT SCORING PROGRAM
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BCAT CROSSWALK TO FUNCTIONAL STATUS
Cognitive Stage
BCAT Range
Cognitive & Functional Issues
Normal
46-50
No functional deficit; independent living; may be
subjective memory complaints but little to no
objective evidence.
Mild Cognitive Impairment (MCI)
34-46
Generally functionally normal, but early specific
functional declines (IADL); subjective and objective
memory deficits. Individuals at lower range more
likely to have more significant cognitive deficits.
Lower scores more suggestive of residential support
needs.
Mild Dementia
26-34
IADL deficits; typically requires residential support
services; clear objective evidence of memory and
other cognitive declines.
Moderate to Severe Dementia
0-25
Moderate (upper end of the range) - Pervasive
functional deficits (IADLs), but ADLs generally intact;
marked deficits in memory and executive functions;
behavioral and psychological symptoms are common;
requires significant residential support. Severe
(lower end of the range) - Needs assistance in
ADLs/IADLs; pervasive cognitive deficits; requires
complex care.
Adapted by Dr. William Mansbach from Mansbach, W. E., MacDougall, E. E., & Rosenzweig, A. S. (2012). The Brief Assessment Tool (BCAT): a new test
emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living. Journal of Clinical and
Experimental Neuropsychology, 34(2), 183-194.
Note: The score ranges reported above are general guidelines based on descriptive statistics from the normative study. They should not be interpreted as
absolutes. The cognitive stages, test score ranges, and cognitive/functional descriptions are not always distinct, but can overlap. The cognitive stages are
determined by plus/minus one standard deviation (SD) from the mean in each category. Modest adjustments were then made based on the entire
neuropsychological batteries administered. The primary purpose of presenting cognitive stages is to use them as a tool for managing function.
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BCAT CROSSWALK WITH MMSE & GDS
Cognitive Stage
BCAT
Range
MMSE
GDS
Cognitive & Functional
Issues
Normal
46-50
28-30
1-2
No functional deficit; independent
living; may be subjective memory
complaints but little to no objective
evidence.
Mild Cognitive Impairment
(MCI)
34-46
24-27
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Generally functionally normal, but early
specific functional declines (IADL);
subjective and objective memory
deficits. Individuals at lower range more
likely to have more significant cognitive
deficits. Lower scores more suggestive
of residential support needs.
Mild Dementia
26-34
19-23
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IADL deficits; typically requires
residential support services; clear
objective evidence of memory and
other cognitive declines.
Moderate to Severe Dementia
0-25
0-18
5-6-7
Moderate (upper end of the range) Pervasive functional deficits (IADLs), but
ADLs generally intact; marked deficits in
memory and executive functions;
behavioral and psychological symptoms
are common; requires significant
residential support. Severe (lower end
of the range) -Needs assistance in
ADLs/IADLs; pervasive cognitive deficits;
requires complex care.
Adapted by Dr. William Mansbach from Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental state. A practical method for grading the cognitive state of
patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198; Reisberg, B., Ferris, S. H., de Leon, M. J., & Cook, T. (1982). The global deterioration scale for
the assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136-1139; & Mansbach, W. E., MacDougall, E. E., & Rosenzweig, A. S. (2012).
The Brief Assessment Tool (BCAT): a new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of
It’s all about function
Practical recommendations
Rehab focus
Value of cognitive exercises as determined
by BCAT scores
Brain fitness
FUNCTION
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What is Brain Fitness
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Cognitive stimulation
Four criteria
– Moderately difficult
– Frequent
– Novel
– Engaging
– (Social) …. For some
BRAIN FITNESS
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How Does Brain Fitness Work?
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Neurons and how they communicate
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Neuroplasticity
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Cognitive Reserve
HOW DOES BRAIN FITNESS WORK
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What Value Does Brain Fitness Bring?
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In SNF:
– More than 3.3 million people
– 70-75% have cognitive impairment
– Roughly 30% mild, 25% moderate, 20% severe
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In ALF:
– 50-70% have dementia (especially Alzheimer’s)
– In our studies, 80% & 2/3 of them have MCI to mild dementia
VALUE OF BRAIN FITNESS
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More on Value…
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Correlations between cognitive impairment and behavioral and
mood issues
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Under-stimulation, over-stimulation problems
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Brain Fitness can engage resident in purposeful activity
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For MCI and mild dementia, it can improve cognitive and mood
functioning (if person-centered)
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Can reduce behavior problems
VALUE OF BRAIN FITNESS
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Types & Brands of Brain Fitness
BRANDS OF BRAIN FITNESS
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Begins with BCAT cognitive assessment
– Can be administered by tech or professional
– Determines which modules and level of difficulty
“Cognitive Task Manager”
– Memory
– Executive functions
– Attention capacity
myBCAT BRAIN FITNESS PROGRAM
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visit www.TheBCAT.com.
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